CN109688959B

CN109688959B - Push-pull surgical instrument end effector actuation using flexible tensioning members

Info

Publication number: CN109688959B
Application number: CN201780054562.6A
Authority: CN
Inventors: N·拉格斯德
Original assignee: Intuitive Surgical Operations Inc
Current assignee: Intuitive Surgical Operations Inc
Priority date: 2016-09-09
Filing date: 2017-09-08
Publication date: 2021-10-01
Anticipated expiration: 2037-09-08
Also published as: CN113598844A; JP2023144088A; KR20240058956A; KR102660671B1; EP4218653A1; EP3949892B1; CN109688959A; KR20220143778A; US20190201150A1; JP7335382B2; EP3949892A1; EP3509523A4; JP2019526333A; US11020138B2; EP3509523B1; JP7044760B2; KR102456414B1; US20210267617A1; JP2022069664A; WO2018049217A1

Abstract

Surgical tools and related methods articulate an actuation rod assembly via actuation of a tensioning member. A surgical tool includes an end effector, an instrument shaft assembly supporting the end effector, a lever assembly drivingly coupled with the end effector, a guide surface, a flexible tensioning member connected to the lever assembly, and an actuation portion. The actuation rod assembly is mounted for sliding movement within the instrument shaft assembly. The flexible tensioning member is connected to the actuator rod assembly at a connection. The flexible tensioning member includes a first portion that extends distally from the connection portion to the guide surface, wraps around the guide surface, and extends proximally from the guide surface. The actuation portion is drivingly coupled with the flexible tensioning member and operable to articulate the tensioning member so as to articulate the actuation rod assembly to actuate the end effector.

Description

Push-pull surgical instrument end effector actuation using flexible tensioning members

Cross Reference to Related Applications

This application claims the benefit of U.S. provisional application No.62/385,642 filed on 9/2016, the entire disclosure of which is incorporated herein by reference in its entirety for all purposes.

Background

Minimally invasive surgical techniques aim to reduce the amount of external tissue that is damaged during diagnostic or surgical procedures, thereby reducing recovery time, discomfort and harmful side effects for the patient. Thus, the average hospital stay for standard surgery can be significantly shortened using minimally invasive surgical techniques. In addition, patient recovery time, patient discomfort, surgical side effects, and off-work time may also be reduced by minimally invasive surgery.

A common form of minimally invasive surgery is endoscopy, and a common form of endoscopy is laparoscopy, which is minimally invasive examination and surgery within the abdominal cavity. In standard laparoscopic surgery, the patient's abdominal cavity is insufflated with gas and the cannula sleeve is passed through a small (about a half inch or less) incision to provide an access port for laparoscopic instruments.

Laparoscopic surgical instruments typically include an endoscope (e.g., a laparoscope) for viewing the surgical field and tools for working at the surgical site. The working tools are generally similar to the tools used in conventional (open) surgery, except that the working end or end effector of each tool is separated from its handle by an extension tube (also referred to as, for example, an instrument shaft or spindle). For example, the end effector may include a clamp, grasper, scissors, stapler, cautery tool, linear cutter, or needle holder.

To perform a surgical procedure, the surgeon passes working tools through the cannula sleeve to the internal surgical site and manipulates them from outside the abdomen. The surgeon views the procedure from a monitor that displays an image of the surgical site taken from the endoscope. For example, similar endoscopic techniques are used for arthroscopy, retroperitoneal endoscopy, pelvic endoscopy, nephroscopy, cystoscopy, sinoscopy, hysteroscopy, urethroscopy, and the like.

Minimally invasive telesurgical robotic systems are being developed to increase the surgeon's dexterity while working on internal surgical sites and to allow the surgeon to operate on the patient from a remote location (outside the sterile field). In telesurgical systems, the surgeon is typically provided with an image of the surgical site at a console. While viewing the three-dimensional image of the surgical site on a suitable viewer or display, the surgeon performs the surgical procedure on the patient by manipulating the master input or control devices of the console. Each master input device controls the motion of a servo-mechanical actuated/articulated surgical instrument. During a surgical procedure, the telesurgical system may provide mechanical actuation and control of various surgical instruments or tools having end effectors that cause a surgeon to perform various functions, such as holding or driving a needle, grasping a blood vessel, dissecting tissue, etc., in response to manipulation of a master input device.

Surgical clamping and cutting tools (e.g., non-robotic linear clamping, stapling and cutting devices, also known as surgical staplers; and electrosurgical vascular sealing devices) have been used in many different surgical procedures. For example, a surgical stapler may be used to resect cancerous or abnormal tissue from the gastrointestinal tract. Many known surgical clamping and cutting devices, including known surgical staplers, have opposing jaws that clamp tissue and an articulated knife for cutting the clamped tissue.

The surgical clamping and cutting tool may include an end effector supported by an instrument shaft to which a replaceable stapler/stapler cartridge (stapler cartridge) is mounted. The jaws of the end effector can be articulated to clamp tissue between the stapler cartridge and the jaws. The stapler cartridge can then be articulated to deploy a stapler from the stapler cartridge to staple tissue clamped between the stapler cartridge and the jaws. The stapler cartridge can include a knife that can be articulated to cut stapled tissue between rows of deployed staplers.

The level of actuation force sufficient to clamp, staple and/or cut tissue can be significant. Furthermore, it is desirable to limit the diameter of the instrument shaft supporting the end effector and to actuate the end effector via a proximal actuation portion that is drivingly coupled with the end effector via a linkage extending through the instrument shaft. It is also desirable that the linkage that extends through the small diameter instrument shaft to drivingly couple the end effector with the proximal actuation portion be robust, economical, and reliable. The surgical tools and related methods presented herein are suitable for delivering sufficient actuation forces to end effectors (such as clamping, stapling, and cutting end effectors) through relatively small diameter instrument shafts in a robust, economical, and reliable manner.

Disclosure of Invention

Surgical tools and related methods are provided in which proximal retraction of a flexible tensioning member is used to transfer a distally directed actuation force through an instrument shaft assembly to an end effector supported by the instrument shaft assembly. The flexible tensioning member is wrapped around a guide surface disposed within the instrument shaft assembly and connected to an actuation rod assembly that moves toward the end effector in response to retraction of the flexible tensioning member. The actuation rod assembly, guide surface, and flexible tensioning member are configured to be enclosed within an elongated, relatively small diameter instrument shaft assembly and to transmit a distally directed actuation force to actuate a surgical end effector, such as to clamp, staple, and cut the surgical end effector.

Accordingly, in one aspect, a surgical tool is provided. The surgical tool includes: an actuation portion, an end effector, an instrument shaft assembly coupling the actuation portion to the end effector, an actuation rod assembly drivingly coupled with the end effector, and a flexible tensioning member. The instrument shaft assembly is elongated along an instrument shaft axis and defines a lumen. The instrument shaft assembly includes a guide surface disposed toward a distal end of the lumen. The actuation rod assembly is slidably mounted within the lumen for translation along the instrument shaft axis relative to the instrument shaft assembly. The flexible tensioning member drivingly couples the actuation portion to the actuation rod assembly. The flexible tensioning member is connected to the actuation lever assembly at a connection that is longitudinally disposed between the actuation portion and the guide surface. The flexible tensioning member includes a first portion extending distally from the connection portion toward the guide surface, wrapping around the guide surface, and extending proximally toward the actuation portion. The actuation portion is operable to increase tension in the first portion of the flexible tensioning member to translate the actuation rod assembly in a distal direction.

In many embodiments, the actuation portion is operable to rotate the instrument shaft assembly about the instrument shaft axis relative to a proximal chassis supporting the instrument shaft assembly. In many embodiments, the actuation rod assembly is constrained to rotate with the instrument shaft assembly about the instrument shaft axis. The surgical tool may include an isolation tube extending along the instrument shaft axis. The isolation tube may be disposed between the connection portion and the actuation portion. The first and second portions of the flexible tensioning member may pass through the isolation tube. The isolation tube may enclose and isolate a mutually twistable length of the first and second portions from a region surrounding the lumen of the isolation tube. Thus, one or more additional actuation members for actuating and/or articulating the end effector may pass through the region surrounding the lumen of the isolation tube and thus be prevented from being adversely affected by the mutual twisting of the first and second portions that results from rotation of the instrument shaft assembly.

The flexible tensioning member may comprise any suitable flexible tensioning member. For example, the flexible tensioning member may comprise an actuation cable. The first portion of the flexible tensioning member may comprise a first length of cable and the second portion of the flexible tensioning member may comprise a second length of cable. The surgical tool may comprise a pulley comprising the guide surface. The actuation portion is operable to move the actuation lever assembly through a range of movement relative to the pulley. The actuator lever assembly may include a slot configured to receive the pulley throughout the range of motion. The actuation lever assembly may include a cable guide aperture through which the second length of cable extends.

In many embodiments, the instrument shaft assembly includes separate components (e.g., separate upper and lower halves) that accommodate insertion of the actuation rod assembly, the guide surface, and the flexible tensioning member into the lumen of the instrument shaft assembly, and that can combine to form the lumen that encloses the actuation rod assembly, the guide surface, and the flexible tensioning member. For example, the instrument shaft assembly can include a first component and a second component. The first and second components may be configured to be suitable for inserting the actuator rod assembly, the guide surface, and the flexible tensioning member into the lumen when the first and second components are uncoupled. The first and second components may be configured to combine to form the lumen.

In many embodiments, the actuation portion is operable to move the actuation rod assembly through a range of movement relative to the guide surface. The actuator lever assembly may include a first guide feature projecting in a first direction and a second guide feature projecting in a second direction different from the first direction. The first and second members may form a first slot sized to receive the first guide feature and a second slot sized to receive the second guide feature throughout the range of movement.

The flexible tensioning member may comprise a suitable flexible tensioning member other than a cable. For example, the flexible tensioning member may comprise a drive belt. The drive belt may include a slot through which a portion of the actuator rod assembly between the connection and the end effector extends. The surgical tool may include a support frame, a first bearing, and a second bearing. The support frame may have an aperture through which a portion of the actuator rod assembly between the connection and the end effector extends. The first bearing may be mounted to the support frame for rotation about a guide surface axis perpendicular to the instrument shaft axis and interface with the drive belt on a first side of the slot. The second bearing may be mounted to the support frame for rotation about the guide surface axis and interface with the drive belt on a second side of the trough opposite the first side of the trough. The actuation lever assembly may include a drive belt guide bore through which the drive belt extends.

In another aspect, a method for actuating an end effector of a surgical tool is provided. The method comprises the following steps: supporting an end effector via an instrument shaft assembly elongated along an instrument shaft axis; enclosing a firing rod assembly within a lumen of the instrument shaft assembly; guiding the actuation rod assembly during movement of the actuation rod assembly along the instrument shaft axis; and operating an actuation portion to increase tension in a first portion of a flexible tensioning member drivingly coupled with the actuation rod assembly to move the actuation rod assembly toward the end effector to actuate the end effector. The first portion of the flexible tensioning member extends distally from the actuation portion to a guide surface, wraps around the guide surface, and extends from the guide surface to a connection between the first portion of the flexible tensioning member and the actuation lever assembly. In many embodiments, the method further comprises operating the actuation portion to increase the tension in the second portion of the flexible tensioning member drivingly coupled with the actuation rod assembly to move the actuation rod assembly away from the end effector.

In many embodiments, the method includes operating the actuation portion to rotate the instrument shaft assembly about the instrument shaft axis relative to a proximal chassis supporting the instrument shaft assembly. The method can include constraining the actuation rod assembly to rotate with the instrument shaft assembly about the instrument shaft axis. The method can include enclosing within an isolation tube mutually twistable lengths of the first and second portions of the flexible tensioning member disposed between the actuation rod assembly and the actuation portion to isolate the mutually twistable lengths from a region of the lumen surrounding the isolation tube.

In many embodiments of the method, the flexible tensioning member comprises a cable. For example, the first portion of the flexible tensioning member may comprise a first length of cable. The second portion of the flexible tensioning member may comprise a second length of cable. The surgical tool may comprise a pulley comprising the guide surface. The method may include operating the actuating portion to move the actuator rod assembly through a range of movement relative to the pulley and receiving the pulley within a slot of the actuator rod assembly throughout the range of movement. The method may include guiding the second length of cable via a cable guide aperture in the actuator lever assembly through which the second length of cable extends.

In many embodiments of the method, an instrument shaft assembly includes separate components (e.g., separate upper and lower halves) that are adapted to insert the actuation rod assembly, the guide surface, and the flexible tensioning member within a lumen of the instrument shaft assembly and that can combine to form the lumen that encloses the actuation rod assembly, the guide surface, and the flexible tensioning member. For example, the method can include inserting the actuation rod assembly, the guide surface, and the flexible tensioning member into a first component of the instrument shaft assembly, and coupling a second component of the instrument shaft assembly to the first component to enclose a portion of the actuation rod assembly, the guide surface, and the flexible tensioning member within the lumen of the instrument shaft assembly.

In many embodiments, the method includes operating the actuation portion to move the actuation rod assembly through a range of movement relative to the guide surface. The method may include interfacing a protruding guide feature of the actuation rod assembly with the instrument shaft assembly to guide movement of the actuation rod assembly through the entire range of movement relative to the instrument shaft assembly.

In many embodiments of the method, the flexible tensioning member may comprise a suitable flexible tensioning member other than a cable. For example, the flexible tensioning member may comprise a drive belt. The method can include receiving a portion of the actuator rod assembly between the coupling portion and the end effector through a slot in the drive belt. The method may include: receiving a portion of the actuation rod extending between the connection and the end effector in a bore of a support frame; a first bearing mounted to the support frame for rotation about a guide surface axis perpendicular to the instrument shaft axis and interfacing with the drive belt on a first side of the slot; and a support second bearing mounted to the support frame for rotation about the guide surface axis and interfacing with the drive belt on a second side of the trough opposite the first side of the trough. In many embodiments, the first and second bearings include the guide surface. The method may include guiding the drive belt via a drive belt guide bore of the actuator lever assembly, the drive belt extending through the drive belt guide bore.

For a fuller understanding of the nature and advantages of the present invention, reference should be made to the following detailed description taken together with the accompanying figures. Other aspects, objects, and advantages of the invention will be apparent from the accompanying drawings and from the detailed description that follows.

Drawings

FIG. 1 is a plan view of a minimally invasive robotic surgical system for performing surgery, according to many embodiments.

Fig. 2 is a perspective view of a surgeon console for a robotic surgical system, according to many embodiments.

Fig. 3 is a perspective view of an electronics cart of a robotic surgical system, in accordance with many embodiments.

Fig. 4 schematically illustrates a robotic surgical system in accordance with many embodiments.

Fig. 5 is a front view of a patient side cart (surgical robot) of a robotic surgical system, in accordance with many embodiments.

Fig. 6 illustrates a robotic surgical tool according to many embodiments.

Fig. 7A and 7B are simplified schematic diagrams illustrating a surgical tool including an end effector and a cable drive mechanism for transferring push/pull actuation forces to the end effector, according to many embodiments.

Fig. 8 is a plan view of the embodiment of the surgical tool of fig. 7A and 7B.

Fig. 9 is a plan view showing components of a cable drive mechanism for transmitting push/pull actuation forces to an end effector of the surgical tool of fig. 8.

Fig. 10 is a close-up view showing components of a cable drive mechanism for transmitting push/pull actuation forces to an end effector of the surgical tool of fig. 8.

Fig. 11 and 12 are views of a proximal actuation mechanism operable to actuate a cable for transmitting push/pull actuation forces to a cable drive mechanism of an end effector of the surgical tool of fig. 8.

Fig. 13A and 13B are simplified schematic diagrams illustrating a surgical tool including an end effector and a belt drive mechanism for transferring push/pull actuation forces to the end effector, according to many embodiments.

Fig. 14 is a plan view of the embodiment of the surgical tool of fig. 13A and 13B.

Fig. 15 and 16 are close-up views illustrating a belt drive shuttle for transmitting push/pull actuation forces to a belt drive mechanism of an end effector of the surgical tool of fig. 14.

Fig. 17 is a close-up view showing drive belt end supports of a belt drive mechanism for transmitting push/pull actuation forces to an end effector of the surgical tool of fig. 14.

Detailed Description

In the following description, various embodiments of the present invention will be described. For purposes of explanation, specific configurations and details are set forth in order to provide a thorough understanding of the embodiments. It will be apparent, however, to one skilled in the art that the present invention may be practiced without these specific details. Furthermore, well-known features may be omitted or simplified in order not to obscure the described embodiments.

Minimally invasive robotic surgery

Referring now to the drawings, in which like reference numerals refer to like parts throughout the several views, FIG. 1 is a plan view illustration of a Minimally Invasive Robotic Surgical (MIRS) system 10 that is generally used to perform minimally invasive diagnostic or surgical procedures on a patient 12 lying on an operating table 14. The system may include a surgeon console 16 for use by a surgeon 18 during a procedure. One or more assistants 20 may also participate in the process. The MIRS system 10 may also include a patient side cart 22 (surgical robot) and an electronics cart 24. The patient side cart 22 can manipulate at least one removably coupled tool assembly 26 (hereinafter simply referred to as a "tool") through a minimally invasive incision in the body of the patient 12 while the surgeon 18 views the surgical site through the console 16. Images of the surgical site may be obtained through an endoscope 28 (such as a stereoscopic endoscope), which endoscope 28 may be manipulated by the patient side cart 22 to orient the endoscope 28. The electronics cart 24 may be used to process images of the surgical site for subsequent display to the surgeon 18 via the surgeon console 16. The number of surgical tools 26 used at one time is generally dependent on the diagnostic or surgical procedure and the space constraints within the operating room, among other factors. If it is desired to change one or more of the tools 26 used during the procedure, the assistant 20 may remove the tool 26 from the patient side cart 22 and replace it with another tool 26 from the tray 30 in the operating room.

Fig. 2 is a perspective view of the surgeon's console 16. The surgeon console 16 includes a left eye display 32 and a right eye display 34 for presenting the surgeon 18 with coordinated stereoscopic views of the surgical site that enable depth perception. The console 16 also includes one or more input control devices 36, which in turn cause the patient side cart 22 (shown in fig. 1) to maneuver one or more tools. Input control 36 may provide the same degrees of freedom as its associated tool 26 (shown in fig. 1) to provide the surgeon with a telepresence or the feel that input control 36 is integral with tool 26 so that the surgeon strongly feels direct control of tool 26. To this end, position, force and tactile feedback sensors (not shown) may be employed to transmit the position, force and tactile sensations from the tool 26 back to the surgeon's hand through the input control device 36.

The surgeon's console 16 is typically located in the same room as the patient so that the surgeon can directly monitor the procedure, be physically present when necessary, and talk directly to the assistant, rather than over a telephone or other communication medium. However, the surgeon may be located in a different room, a completely different building, or other remote location of the patient, allowing for a telesurgical procedure.

Fig. 3 is a perspective view of the electronics cart 24. The electronics cart 24 may be coupled with the endoscope 28 and may include a processor for processing captured images for subsequent display to a surgeon, such as on a surgeon console or on another suitable display located locally and/or remotely. For example, where a stereoscopic endoscope is used, the electronics cart 24 may process the captured images to present the surgeon with coordinated stereoscopic images of the surgical site. Such coordination may include alignment between the opposing images and may include adjusting the stereoscopic working distance of the stereoscopic endoscope. As another example, image processing may include using previously determined camera calibration parameters to compensate for imaging errors of the image capture device, such as optical aberrations.

Fig. 4 schematically illustrates a robotic surgical system 50 (such as the MIRS system 10 of fig. 1). As described above, a surgeon may use a surgeon console 52 (such as surgeon console 16 in fig. 1) to control a patient side cart (surgical robot) 54 (such as patient side cart 22 in fig. 1) during a minimally invasive procedure. The patient side cart 54 may capture images of the surgical site using an imaging device, such as a stereoscopic endoscope, and output the captured images to an electronics cart 56 (such as electronics cart 24 in fig. 1). As discussed above, the electronics cart 56 may process the captured image in various ways prior to any subsequent display. For example, the electronics cart 56 may overlay the captured images with a virtual control interface, and then display the combined images to the surgeon via the surgeon console 52. The patient side cart 54 may output the captured images for processing outside the electronics cart 56. For example, the patient side cart 54 may output the captured images to the processor 58, which the processor 58 may use to process the captured images. The images may also be processed by a combination of the electronics cart 56 and the processor 58, which electronics cart 56 and processor 58 may be coupled together to process the captured images jointly, sequentially, and/or in combinations thereof. One or more separate displays 60 may also be coupled with the processor 58 and/or the electronics cart 56 for displaying images, such as images of the surgical site or other related images, locally and/or remotely.

Fig. 5 shows the patient side cart 22. The illustrated patient side cart 22 provides for the manipulation of three surgical tools 26 and an imaging device 28, such as a stereoscopic endoscope for capturing images of the surgical site. The steering is provided by a robotic mechanism having a plurality of robotic joints. The imaging device 28 and the surgical tool 26 may be positioned and manipulated through an incision in the patient such that the remote center of motion is maintained at the incision to minimize the size of the incision. The image of the surgical site may include an image of the distal end of the surgical tool 26 as it is positioned within the field of view of the imaging device 28.

Fig. 6 illustrates a robotic surgical tool 100 according to many embodiments. Robotic surgical tool 100 is an example of surgical tool 26. Surgical tool 100 includes an end effector 102, an elongate instrument shaft assembly 104, and a proximal assembly 106. The instrument shaft assembly 104 supports the end effector 102 at the distal end of the instrument shaft assembly 104. The proximal assembly 106 includes a proximal chassis 108 and an actuation portion 110 supported by the proximal chassis 108. Actuation portion 110 is configured to articulate an actuation cable for articulating an actuation rod assembly mounted for translation along a lumen of instrument shaft assembly 104. The actuation rod assembly includes an actuation rod that is drivingly coupled with the end effector 102 to transfer push/pull actuation forces to the end effector 102. The push/pull actuation force transmitted to the end effector 102 may be used to actuate any suitable mechanism of the end effector 102, such as a jaw articulation mechanism for clamping tissue, a stapler deployment mechanism for deploying a stapler into the clamped tissue, and/or a cutting mechanism for cutting tissue clamped and stapled by the end effector 102.

Fig. 7A and 7B are simplified schematic diagrams illustrating a surgical tool 100. Surgical tool 100 includes a cable drive mechanism 112 for transmitting push/pull actuation forces to end effector 102. The cable drive mechanism 112 includes an actuator rod assembly 114, a pulley assembly 116, an actuator cable 118, and an isolation tube 140. The actuation rod assembly 114 includes a shuttle 120 and an actuation rod 122 fixedly attached to the shuttle 120. The instrument shaft assembly 104 has a lumen 124, which lumen 124 extends from a proximal end 126 of the instrument shaft assembly 104 to a distal end 128 of the instrument shaft assembly 104. The instrument shaft assembly 104 is elongated along an instrument shaft axis 130. Shuttle 120 is disposed within lumen 124 and is mounted within instrument shaft assembly 104 for translation along lumen 124 parallel to instrument shaft axis 130. The pulley assembly 116 includes a pulley 132 and a pulley support 134 that supports the pulley 132 and is coupled to the instrument shaft assembly 104. Actuation cable 118 is attached to shuttle 120 at connection 136. A first section of actuation cable 118 extends distally from connection 136 to pulley 132, passes around pulley 132, extends proximally from pulley 132 to a guide bore 138 through a proximal portion of shuttle 120, extends through guide bore 138, extends proximally from guide bore 138 to isolation tube 140, extends through isolation tube 140, extends proximally from isolation tube 140 to capstan 142 of actuation portion 110, and wraps around capstan 142 in a first direction. A second section of actuation cable 118 extends proximally from connection 136 to isolation tube 140, through isolation tube 140, proximally from isolation tube 140 to capstan 142, and wraps around capstan 142 in a second direction opposite the first direction.

The controlled rotation of capstan 142 serves to control the translation of shuttle 120 along lumen 124. In the illustrated embodiment, counterclockwise rotation of capstan 142 pulls the first section of actuation cable 118 toward capstan 142 (and accommodates distal advancement of the second section of actuation cable 118), thereby pulling shuttle 120 distally toward end effector 102. Pulling the shuttle 120 distally pushes the actuation rod 122 toward the end effector 102. For example, the capstan 142 can be rotated to advance the shuttle 120 from the proximal position shown in FIG. 7A to the distal position shown in FIG. 7B, thereby advancing the actuation rod 122 distally through an actuation stroke. In a similar manner, the capstan 142 can be rotated to retract the shuttle 120 from the distal position shown in FIG. 7B to the proximal position shown in FIG. 7A, thereby retracting the actuation rod 122 proximally through the actuation stroke. In the illustrated embodiment, the shuttle 120 has a central slot configured to accommodate the pulley assembly 116 for all positions of the shuttle 120 from the proximal position shown in fig. 7A to the distal position shown in fig. 7B.

Articulation of the actuation rod 122 may be used to transfer a significant actuation force to the end effector 102 to actuate any suitable mechanism of the end effector 102. For example, articulation of the actuation lever 122 from the proximal position shown in fig. 7A to the distal position shown in fig. 7B and/or from the distal position shown in fig. 7B to the proximal position shown in fig. 7A can be used to articulate jaws of the end effector to clamp tissue between the jaws and a replaceable stapler cartridge mounted to the end effector 102, articulate the stapler cartridge to deploy a stapler from the stapler cartridge into tissue clamped between the stapler cartridge and the jaws, and/or articulate a cutting element to cut tissue clamped between the stapler cartridge and the jaws and stapled via a stapler deployed from the stapler cartridge into the clamped tissue.

In many embodiments, the instrument shaft assembly 104 is mounted to the proximal assembly 106 for controlled rotation of the instrument shaft assembly 104 relative to the proximal chassis 108 about an instrument shaft axis 130. In many embodiments, the shuttle 120 is mounted within the lumen 124 for rotation with the instrument shaft assembly 104. As shuttle 120 rotates with rotation of the instrument shaft assembly 104, a portion of the second section of actuation cable 118 (extending proximally from coupling portion 136 to capstan 142) and a portion of the first section of actuation cable 118 (extending proximally from guide bore 138 to capstan 142) will twist relative to each other depending on the amount of rotation of the instrument shaft assembly 104 relative to the proximal chassis 108. In many embodiments, the isolation tube 140 is configured to enclose and/or constrain the position of at least a portion of the mutually twisted portions of the actuation cable 118. Isolation tube 140 may be used to isolate one or more other actuation members for an end effector disposed in lumen 124 surrounding isolation tube 140 from the mutually twisted portions of actuation cable 118 to prevent the mutual twisting of actuation cable 118 from interfering with the one or more other actuation members surrounding it.

Fig. 8-12 illustrate an embodiment of the surgical tool 100 of fig. 7A and 7B. Fig. 8 illustrates an embodiment of the end effector 102, a partial view of the instrument shaft assembly 104, the proximal assembly 106, the pulley assembly 116, the shuttle 120, the actuation rod 122, and the isolation tube 140. Fig. 9 is a plan view of the embodiment of surgical tool 100 of fig. 8, showing a partial view of instrument shaft assembly 104, pulley assembly 116, shuttle 120, actuation rod 122, and isolation tube 140.

Fig. 10 is a close-up view of the embodiment of the surgical tool 100 of fig. 8, showing the first member 104(1) of the instrument shaft assembly 104, the pulley assembly 116, the shuttle 120, the actuation rod 122, the actuation cable 118, and the isolation tube 140. The mating second components of the instrument shaft assembly 104 are not shown in fig. 10. In the illustrated embodiment, the instrument shaft assembly 104 includes the illustrated first component 104(1) and mating second component (not shown in fig. 10) of the instrument shaft assembly 104 to enable the actuation rod assembly 114 (which includes the shuttle 120 and the actuation rod 122), the pulley assembly 116, the isolation tube 140, and the actuation cable 118 to be installed into the lumen 124 of the instrument shaft assembly 104. In the illustrated embodiment, the shuttle 120 includes a first guide feature 144 that projects in a first direction and a second guide feature 146 that projects in a second direction different from the first direction. In the illustrated embodiment, the second direction is in an opposite direction to the first direction. The first part 104(1) and the mating second part of the instrument shaft assembly 104 form a first slot 148 sized to receive the first guide feature 144 and a second slot 150 sized to receive the second guide feature 146 to limit the shuttle 120 to translate along the instrument shaft axis 130 throughout the range of motion of the shuttle 120 relative to the instrument shaft assembly 104. The first member 104(1) and the mating second member of the instrument shaft assembly 104 are also configured to enable installation of the pulley assembly 116 into the lumen 124 of the instrument shaft assembly 104. For example, the first member 104(1) and the mating second member of the instrument shaft assembly 104 can include recesses configured to receive and interface with the interface portion of the pulley support 134, thereby capturing the pulley support 134 and constraining the pulley support 134 within the lumen 124 of the instrument shaft assembly 104. In a similar manner, the first component 104(1) and the mating second component of the instrument shaft assembly 104 are also configured to enable installation of the isolation tube 140 into the lumen 124 of the instrument shaft assembly 104. For example, the first member 104(1) and the mating second member of the instrument shaft assembly 104 can include recesses configured to receive and interface with an interface portion of the isolation tube 140, thereby capturing the isolation tube 140 and constraining the isolation tube 140 within the lumen 124 of the instrument shaft assembly 104.

Fig. 11 and 12 are views of the proximal assembly 106 of the surgical tool 100. Actuation cable 118 passes around winch 142. The capstan 142 is mounted for rotation about a capstan axis 152 that is perpendicular to the instrument shaft axis 130. Controlled rotation of winch 142 via actuation input 154 controls the extension and retraction of the first and second sections of actuation cable 118 in order to control the transfer of actuation forces to end effector 102 via actuation rod 122. In the illustrated embodiment, the winch 142 includes an adjustment feature operable to adjust the tension and/or remove slack from the actuation cable 118.

Fig. 13A and 13B are simplified schematic diagrams illustrating a surgical tool 200. Surgical tool 200 is similar to surgical tool 100, but does not include cable drive mechanism 112, but rather includes a belt drive mechanism 212 for transmitting push/pull actuation forces to end effector 102. The belt drive mechanism 212 includes an actuator rod assembly 214, a drive belt end support 216, a drive belt 218, and an isolation tube 240. The actuation lever assembly 214 includes a shuttle 220 and an actuation lever 222 fixedly attached to the shuttle 220. The instrument shaft 204 has a lumen 224, the lumen 224 extending from a proximal end 226 of the instrument shaft 204 to a distal end 228 of the instrument shaft 204. The instrument shaft 204 is elongated along an instrument shaft axis 230. Shuttle 220 is disposed within lumen 224 and is coupled to instrument shaft 204 for translation along lumen 224 along instrument shaft axis 230. The drive belt end support 216 includes a drive belt end support frame 234 that supports a first bearing 232a and a second bearing 232 b. A drive belt end support frame 234 is disposed within the lumen 224 and is mounted to the instrument shaft 204. Drive belt 218 is attached to shuttle 220 at connection 236. A first section of drive band 218 extends distally from coupling portion 236 to first and second bearings 132a, 132b, passes around first and second bearings 132a, 132b, extends proximally from first and second bearings 132a, 132b to a guide bore through shuttle 220 on a side of shuttle 220 opposite coupling portion 236, extends through the guide bore, extends proximally from the guide bore to isolation tube 240, extends through isolation tube 240, extends proximally from isolation tube 240 to capstan 242 of actuation portion 210, and wraps around capstan 242 in a first direction. A second section of cable 218 extends proximally from connection 236 to isolation tube 240, through isolation tube 240, proximally from isolation tube 240 to capstan 242, and wraps around capstan 242 in a second direction opposite the first direction.

Controlled rotation of capstan 242 serves to control translation of shuttle 220 along lumen 224. In the illustrated embodiment, rotation of capstan 242 in a first direction pulls a first section of drive belt 218 toward capstan 242 (and accommodates distal advancement of a second section of drive belt 218), thereby pulling shuttle 220 distally toward end effector 102. Pulling the shuttle 220 distally pushes the actuation rod 222 toward the end effector 102. For example, capstan 242 can be rotated to advance shuttle 220 from the proximal position shown in FIG. 13A to the distal position shown in FIG. 13B, thereby advancing actuation rod 222 distally through an actuation stroke. In a similar manner, capstan 242 can be rotated to retract shuttle 220 from the distal position shown in FIG. 13B to the proximal position shown in FIG. 13A, thereby retracting actuation rod 222 proximally through an actuation stroke.

Articulation of the actuation rod 222 may be used to transfer a significant actuation force to the end effector 102 to actuate any suitable mechanism of the end effector 102. For example, articulation of actuation lever 222 from the proximal position shown in fig. 13A to the distal position shown in fig. 13B and/or from the distal position shown in fig. 13B to the proximal position shown in fig. 13A can be used to articulate jaws of an end effector to clamp tissue between the jaws and a replaceable stapler cartridge mounted to end effector 102, articulate a stapler cartridge to deploy a stapler from the stapler cartridge into tissue clamped between the stapler cartridge and the jaws, and/or articulate a cutting element to cut tissue clamped between the stapler cartridge and the jaws and stapled via a stapler deployed from the stapler cartridge into the clamped tissue.

In the illustrated embodiment, the instrument shaft 204 is mounted to the proximal assembly 206 for controlled rotation of the instrument shaft 204 relative to the proximal chassis 208 about an instrument shaft axis 230. In many embodiments, the shuttle 220 is mounted within the lumen 224 for rotation with the instrument shaft 204. As shuttle 220 rotates with rotation of instrument shaft 204, a portion of the second section of drive belt 218 (extending proximally from coupling 236 to capstan 242) and a portion of the first section of drive belt 218 (extending proximally from the guide hole in shuttle 220 to capstan 242) will twist relative to each other depending on the amount of rotation of instrument shaft 204 relative to proximal chassis 208. In many embodiments, the isolation tube 240 is configured to close and/or constrain the position of at least a portion of the mutually twisted portion of the drive belt 218. Isolation tube 240 may be used to isolate one or more other actuating members for end effector 102 disposed in lumen 224 around isolation tube 240 from the mutually torqued portion of drive band 218 to prevent mutual torqueing of drive band 218 from interfering with one or more other actuating members around.

Fig. 14-17 illustrate an embodiment of the surgical tool 200 of fig. 13A and 13B. Fig. 14 shows an embodiment of the end effector 102, instrument shaft 204, proximal assembly 206, drive band end support 216, shuttle 220, actuation rod 222, and isolation tube 240. Fig. 15 is a close-up view showing the shuttle 220, drive belt 218, actuation lever 222, first part 204(1) of the instrument shaft 204 (the second part 204(2) of the instrument shaft 204 is not shown in fig. 15), and the connection 236 between the drive belt 218 and the shuttle 220. In the illustrated embodiment, the attachment portion 236 includes two lug bolts 237 that extend through corresponding holes in the drive belt 218 and mate with corresponding threaded holes in the shuttle 220, thereby securing a partial portion of the drive belt 218 to the shuttle 220.

In the illustrated embodiment, the instrument shaft 204 includes the illustrated first part 204(1) and mating second part 204(2) of the instrument shaft 204 (not shown in fig. 15 and shown in fig. 16) to enable installation of the actuation rod assembly 214 (which includes the shuttle 220 and the actuation rod 222), the drive band end support 216, the isolation tube 240, and the drive band 218 into the lumen 224 of the instrument shaft 204. In the illustrated embodiment, the shuttle 220 includes a first guide feature 244 that protrudes in a first direction and a second guide feature 246 (hidden in fig. 15) that protrudes in a second direction different from the first direction. In the illustrated embodiment, the second direction is in an opposite direction to the first direction. The first member 204(1) of the instrument shaft 204 has a first slot 248 sized to receive the second guide feature 246, and the second member 204(2) has a second slot 250 sized to receive the first guide feature 244 to constrain the shuttle 220 to translate along the instrument shaft axis 230 throughout the range of motion of the shuttle 220 relative to the instrument shaft 204. The first part 204(1) and mating second part 204(2) of the instrument shaft assembly 104 are also configured to enable mounting of the drive belt end support 216 into the lumen 224 of the instrument shaft 204. For example, the first and mating second parts 204(1, 204 (2)) of the instrument shaft 204 can include recesses configured to receive and interface with the interface portion of the drive belt end support frame 234, thereby capturing the drive belt end support 216 and constraining the drive belt end support 216 within the lumen 224 of the instrument shaft 204. In a similar manner, the first component 204(1) and the mating second component 204(2) of the instrument shaft 204 are also configured to enable installation of the isolation tube 240 into the lumen 224 of the instrument shaft 204. For example, the first component 204(1) and the mating second component 204(2) of the instrument shaft 204 may include recesses configured to receive and interface with the interface portion of the isolation tube 240, thereby capturing the isolation tube 240 and constraining the isolation tube 240 within the lumen 224 of the instrument shaft 204.

Fig. 16 is a close-up view showing the shuttle 220 and guide

pins

238a, 238b forming a guide slot through which the drive belt 218 extends. During actuation of the shuttle 220 via actuation of the drive belt 218, the drive belt 218 slides through the guide slot between the guide pins 238a, 238b and the shuttle 220. Fig. 16 also shows the second guide feature 246 and the second part 204(2) of the instrument shaft 204.

Fig. 17 is a close-up view showing the drive belt end support 216. The drive belt end support 216 includes a drive belt end support frame 234 and first and

second bearings

232a and 232b mounted on the drive belt end support frame 234 for rotation about a drive belt end support axis 252, the drive belt end support axis 252 being perpendicular to the instrument shaft axis 230 and parallel to the sides of the drive belt 218. The drive belt end support frame 234 has an aperture 254 sized to receive the actuation rod 222, the actuation rod 222 extending through the aperture 254. The drive belt end support frame 234 includes a first end journal 256 and a second end journal 258, the first end journal 256 and the second end journal 258 cooperating with complementary shaped recesses in the instrument shaft 204 to support the drive belt end support frame 234 at a fixed position within the interior cavity 224 of the instrument shaft 204.

Other variations are also within the spirit of the invention. For example, although five different types of stapler cartridge are described herein, any suitable number of stapler cartridge types may be employed, including fewer and more than the five stapler cartridge types described. Accordingly, while the invention is susceptible to various modifications and alternative constructions, certain illustrated embodiments thereof are shown in the drawings and have been described above in detail. It should be understood, however, that there is no intention to limit the invention to the specific form or forms disclosed, but on the contrary, the intention is to cover all modifications, alternative constructions, and equivalents falling within the spirit and scope of the invention, as defined in the appended claims.

The use of the terms "a" and "an" and "the" and similar referents in the context of describing the invention (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. The terms "comprising," "having," "including," and "containing" are to be construed as open-ended terms (i.e., meaning "including, but not limited to,") unless otherwise noted. The term "connected" should be understood as partially or wholly contained within, attached to, or joined together even if there is some intervening matter. Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., "such as") provided herein, is intended merely to better illuminate embodiments of the disclosure and does not pose a limitation on the scope of the disclosure unless otherwise claimed. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the invention.

Preferred embodiments of this invention are described herein, including the best mode known to the inventors for carrying out the invention. Variations of those preferred embodiments may become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventors expect skilled artisans to employ such variations as appropriate, and the inventors intend for the invention to be practiced otherwise than as specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contradicted by context.

All references, including publications, patent applications, and patents, cited herein are hereby incorporated by reference to the same extent as if each reference were individually and specifically indicated to be incorporated by reference and were set forth in its entirety herein: as if each reference were individually and specifically indicated to be incorporated by reference herein and set forth in its entirety.

Claims

1. A surgical tool, comprising:

an actuation portion comprising a capstan;

an end effector;

an instrument shaft assembly coupling the actuation portion to the end effector, the instrument shaft assembly elongated along an instrument shaft axis and defining a lumen, the instrument shaft assembly including a guide surface disposed toward a distal end of the lumen;

an actuation rod assembly drivingly coupled with the end effector, the actuation rod assembly being slidably mounted within the lumen for translation relative to the instrument shaft along the instrument shaft axis; and

a flexible tensioning member drivingly coupling the winch to the actuation lever assembly; the flexible tensioning member is connected to the actuation lever assembly at a connection longitudinally disposed between the capstan and the guide surface; the flexible tensioning member comprises a first portion and a second portion, wherein the first portion extends distally from the connecting portion toward the guide surface, wraps around the guide surface, extends proximally to and wraps around the capstan; the capstan is rotatable in a first direction to increase tension in the first portion to translate the actuation rod assembly in a distal direction, wherein the second portion extends proximally from the connection to the capstan and wraps around the capstan in a direction opposite the first portion, the capstan is rotatable in a second direction to increase tension in the second portion to translate the actuation rod assembly in a proximal direction, and wherein the second direction is opposite the first direction.

2. The surgical tool of claim 1, wherein the flexible tensioning member includes a second portion extending proximally from the connection portion through the lumen to the actuation portion, the actuation portion being drivingly coupled with the second portion and operable to increase tension in the second portion to move the actuation rod assembly in a proximal direction.

3. The surgical tool of claim 1, wherein:

the actuation portion is operable to rotate the instrument shaft assembly about the instrument shaft axis relative to a proximal chassis supporting the instrument shaft assembly;

the actuation rod assembly is constrained to rotate with the instrument shaft assembly about the instrument shaft axis; and is

The surgical tool further includes an isolation tube extending along the instrument shaft axis, the isolation tube disposed between the connecting portion and the capstan, the first and second portions of the flexible tensioning member passing through the isolation tube, the isolation tube enclosing a mutually twistable length of the first and second portions and isolating the mutually twistable length from a region of the lumen surrounding the isolation tube.

4. The surgical tool of claim 1, wherein:

the first portion of the flexible tensioning member comprises a first length of cable;

the second portion of the flexible tensioning member comprises a second length of cable;

the surgical tool comprises a pulley comprising the guide surface;

the winch is rotatable to move the actuation lever assembly through a range of movement relative to the pulley; and is

The actuation lever assembly includes a slot configured to receive the pulley throughout the range of motion.

5. The surgical tool of claim 4, wherein the actuation rod assembly includes a cable guide hole through which the second length of cable extends.

6. The surgical tool of claim 1, wherein the instrument shaft assembly comprises first and second components configured to be suitable for inserting the actuation rod assembly, the guide surface, and the flexible tensioning member into the lumen when the first and second components are uncoupled, the first and second components configured to combine to form the lumen.

7. The surgical tool of claim 6, wherein:

the winch is rotatable to move the actuation lever assembly through a range of movement relative to the guide surface;

the actuator rod assembly includes a first guide feature projecting in a first direction and a second guide feature projecting in a second direction different from the first direction; and is

The first and second members form a first slot sized to receive the first guide feature and a second slot sized to receive the second guide feature throughout the range of movement.

8. The surgical tool of claim 1, wherein:

the flexible tensioning member comprises a drive belt; and is

The drive belt includes a slot through which a portion of the actuation lever assembly between the connection and the end effector extends.

9. The surgical tool of claim 8, comprising:

a support frame having an aperture through which the portion of the actuation rod assembly between the connection and the end effector extends;

a first bearing mounted to the support frame for rotation about a guide surface axis perpendicular to the instrument shaft axis and interfacing with the drive belt on a first side of the slot; and

a second bearing mounted to the support frame for rotation about the guide surface axis and interfacing with the drive belt on a second side of the trough opposite the first side of the trough,

wherein the first bearing and the second bearing comprise the guide surface.

10. The surgical tool of claim 8, wherein the actuation lever assembly includes a drive belt guide bore through which the drive belt extends.